Andrew Sharp1, Lucy C Chappell2, Gustaaf Dekker3, Sanja Pelletier4, Yves Garnier4, Onur Zeren4, Katharina M Hillerer5, Thorsten Fischer5, Paul T Seed2, Mark Turner6, Andrew H Shennan2, Zarko Alfirevic6. 1. Department of Women's and Children's Health Research, University of Liverpool, United Kingdom. Electronic address: asharp@liv.ac.uk. 2. Women's Health Academic Centre, King's College London, United Kingdom. 3. Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, University of Adelaide, Australia. 4. Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Osnabrück, Lehrkrankenhaus der Universität Münster, Germany. 5. Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria. 6. Department of Women's and Children's Health Research, University of Liverpool, United Kingdom.
Abstract
OBJECTIVES: Placental Growth Factor (PlGF) has been shown to be beneficial in diagnosing pre-eclampsia. We performed a prospective cohort study of revealed PlGF in standard clinical use in four teaching hospitals in UK, Germany, Austria and Australia. STUDY DESIGN: Clinical data from women with suspected pre-eclampsia or fetal growth restriction <35 weeks' gestation with revealed PlGF measurement were collected (MAPPLE study). MAIN OUTCOME MEASURES: Data were compared to the PELICAN study (PlGF concealed). Pre-specified outcomes were compared using standard statistical tests (median difference or Risk Ratio). The results were further categorised by PlGF concentration: i) very low (<12 pg/ml), ii) low (12-100 pg/ml), iii) normal (>100 pg/ml). RESULTS: 396 women managed with revealed PlGF (MAPPLE) were compared with 287 women with concealed PlGF (PELICAN). Revealed PlGF led to delivery 1.4 weeks earlier (-2.0 to -0.9, 34.9 weeks vs 36.7 weeks). There were no significant differences in maternal adverse outcomes (11.9% vs 10.1%, Risk Ratio (RR) 1.17, 95% CI 0.76-1.82) or caesarean sections (73.8% vs 64.5%; RR 1.14, 95% CI 1.03-1.26). Revealed PlGF led to fewer perinatal deaths (2 vs 9; RR 0.16, 95% CI 0.03-0.74) and fewer babies with birthweight <3rd centile (28.9% vs 36.1%; RR 0.80, 0.65-0.99), but with more neonatal adverse outcomes (30.4% vs 17.1%; RR 1.78, 95% CI 1.32-2.41). CONCLUSIONS: Revealed PlGF may be associated with lower perinatal mortality and birthweight <3rd centile but appears to lead to earlier delivery with more neonatal respiratory morbidity. Randomised trials with adequate power for clinical outcomes are needed. FUNDING: Financial assistance was received from Alere to support the running of the MAPPLE database. Alere had no access to the information or control over the database itself.
OBJECTIVES:Placental Growth Factor (PlGF) has been shown to be beneficial in diagnosing pre-eclampsia. We performed a prospective cohort study of revealed PlGF in standard clinical use in four teaching hospitals in UK, Germany, Austria and Australia. STUDY DESIGN: Clinical data from women with suspected pre-eclampsia or fetal growth restriction <35 weeks' gestation with revealed PlGF measurement were collected (MAPPLE study). MAIN OUTCOME MEASURES: Data were compared to the PELICAN study (PlGF concealed). Pre-specified outcomes were compared using standard statistical tests (median difference or Risk Ratio). The results were further categorised by PlGF concentration: i) very low (<12 pg/ml), ii) low (12-100 pg/ml), iii) normal (>100 pg/ml). RESULTS: 396 women managed with revealed PlGF (MAPPLE) were compared with 287 women with concealed PlGF (PELICAN). Revealed PlGF led to delivery 1.4 weeks earlier (-2.0 to -0.9, 34.9 weeks vs 36.7 weeks). There were no significant differences in maternal adverse outcomes (11.9% vs 10.1%, Risk Ratio (RR) 1.17, 95% CI 0.76-1.82) or caesarean sections (73.8% vs 64.5%; RR 1.14, 95% CI 1.03-1.26). Revealed PlGF led to fewer perinatal deaths (2 vs 9; RR 0.16, 95% CI 0.03-0.74) and fewer babies with birthweight <3rd centile (28.9% vs 36.1%; RR 0.80, 0.65-0.99), but with more neonatal adverse outcomes (30.4% vs 17.1%; RR 1.78, 95% CI 1.32-2.41). CONCLUSIONS: Revealed PlGF may be associated with lower perinatal mortality and birthweight <3rd centile but appears to lead to earlier delivery with more neonatal respiratory morbidity. Randomised trials with adequate power for clinical outcomes are needed. FUNDING: Financial assistance was received from Alere to support the running of the MAPPLE database. Alere had no access to the information or control over the database itself.
Authors: Kate E Duhig; Jenny Myers; Paul T Seed; Jenie Sparkes; Jessica Lowe; Rachael M Hunter; Andrew H Shennan; Lucy C Chappell Journal: Lancet Date: 2019-04-01 Impact factor: 79.321
Authors: Joanna Gent; Sian Bullough; Jane Harrold; Richard Jackson; Kerry Woolfall; Lazaros Andronis; Louise Kenny; Christine Cornforth; Alexander E P Heazell; Emily Benbow; Zarko Alfirevic; Andrew Sharp Journal: Pilot Feasibility Stud Date: 2020-11-19
Authors: Kate E Duhig; Louise M Webster; Andrew Sharp; Carolyn Gill; Paul T Seed; Andrew H Shennan; Jenny E Myers; Lucy C Chappell Journal: Acta Obstet Gynecol Scand Date: 2020-02-29 Impact factor: 3.636
Authors: Charles A Okai; Manuela Russ; Manja Wölter; Kristin Andresen; Werner Rath; Michael O Glocker; Ulrich Pecks Journal: J Clin Med Date: 2020-05-07 Impact factor: 4.241
Authors: D Hayes-Ryan; A S Khashan; K Hemming; C Easter; D Devane; D J Murphy; A Hunter; A Cotter; F M McAuliffe; J J Morrison; F M Breathnach; E Dempsey; L C Kenny; K O'Donoghue Journal: BMJ Date: 2021-08-13